Individual
HENRY M. NEILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10 CENTURY HILL DR, LATHAM, NY 12110-2162
(518) 783-5563
(518) 785-5708
Mailing address
10 CENTURY HILL DR, LATHAM, NY 12110-2162
(518) 783-5563
(518) 785-5708
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
166524-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000401569001
BLUE SHIELD OF NENY
NY
05
—
00962767
—
NY
01
—
10001463
CDPHP
NY
01
—
26207
MVP
NY
Enumeration date
08/20/2006
Last updated
07/08/2007
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